Multicentre observational screening survey for the detection of CTEPH following pulmonary embolism
Multicentre observational screening survey for the detection of CTEPH following pulmonary embolism
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DOI：
10.1183/13993003.02505-2017
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发表时间：
2018-04-01
影响因子：
24.3
通讯作者：
Aubert, John-David
中科院分区：
文献类型：
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作者：
Coquoz, Nicolas;Weilenmann, Daniel;Aubert, John-David
慢性血栓栓塞性肺动脉高压（CTEPH）是肺栓塞的严重并发症。肺栓塞后的发病率仍有争议。目前尚不推荐对急性肺栓塞患者进行CTEPH的主动筛查。肺栓塞后慢性血栓栓塞性肺动脉高压（CTEPH）检测的多中心观察筛选调查（PE输入）; ISRCTN 61417303）纳入了2009年3月至2016年11月期间来自瑞士11个中心的急性肺栓塞患者。在6个月、12个月和24个月时采用逐步算法进行可能的CTEPH筛查，包括基于呼吸困难电话的调查、经胸超声心动图、右心导管插入术和CTEPH的放射学确认。在1699例肺栓塞患者中，对508例患者进行了为期2年的CTEPH筛查评估。肺栓塞后CTEPH的发生率为3.7/1000患者-年，2年累积发生率为0.79%。2016年12月咨询的瑞士肺动脉高压登记研究未报告这些患者的其他CTEPH病例。该调查的敏感性为100%，特异性为81.6%。在新发呼吸困难患者中，第二步超声心动图显示阴性预测值为100%。CTEPH是一种罕见但可治疗的疾病。推荐一种简便、敏感的方法用于急性肺栓塞患者CTEPH的筛查。
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe complication of pulmonary embolism. Its incidence following pulmonary embolism is debated. Active screening for CTEPH in patients with acute pulmonary embolism is yet to be recommended.This prospective, multicentre, observational study (Multicentre Observational Screening Survey for the Detection of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Following Pulmonary Embolism (INPUT on PE); ISRCTN61417303) included patients with acute pulmonary embolism from 11 centres in Switzerland from March 2009 to November 2016. Screening for possible CTEPH was performed at 6, 12 and 24 months using a stepwise algorithm that included a dyspnoea phone-based survey, transthoracic echocardiography, right heart catheterisation and radiological confirmation of CTEPH.Out of 1699 patients with pulmonary embolism, 508 patients were assessed for CTEPH screening over 2 years. CTEPH incidence following pulmonary embolism was 3.7 per 1000 patient-years, with a 2-year cumulative incidence of 0.79%. The Swiss pulmonary hypertension registry consulted in December 2016 did not report additional CTEPH cases in these patients. The survey yielded 100% sensitivity and 81.6% specificity. The second step echocardiography in newly dyspnoeic patients showed a negative predictive value of 100%.CTEPH is a rare but treatable disease. A simple and sensitive way for CTEPH screening in patients with acute pulmonary embolism is recommended.